1. Health System in India
Organization and Administration at
Central, State and District Levels
2. Learning Objectives
• Explain the constitutional basis of the health system in India
• Describe organization and administration at the Central level
• Describe organization and administration at the State level
• Describe organization and administration at the District and
below
• Interpret organizational charts at each level for exam answers
3. Constitutional and Policy Basis
• Seventh Schedule State List includes public health and
sanitation; hospitals and dispensaries
• Concurrent List includes population control and family
planning; drugs and poisons; adulteration of foodstuffs
• 73rd and 74th Constitutional Amendments institutionalized
Panchayats and Municipalities
• National Health Policy 2017 and National Health Mission
provide policy and program frameworks
4. Overview of Public Health System
• Federal governance: Union,
State, and Local Government
• Public providers:
Sub-Centre/Health & Wellness
Centre, PHC, CHC, SDH, DH
• Urban providers: UPHC, UCHC,
District Hospitals
• Regulators and knowledge
bodies: MoHFW, DGHS,
DHR/ICMR, NCDC, CDSCO,
NHSRC
• Key programs: National Health
Mission, Ayushman Bharat
(HWCs and PM-JAY)
• Devolution to PRIs and Urban
Local Bodies for local health
functions
• Standards: Indian Public
Health Standards 2022 (IPHS)
• Digital health: ABHA,
eHospital/HIMS in many states
5. Central Level Union Ministry of
Health and Family Welfare
• Two Departments: Department of Health & Family Welfare
and Department of Health Research
• Attached offices and agencies provide technical, regulatory,
and program support
• Policy making, national programs, financing support to States,
standard-setting
6. Directorate General of Health
Services
• Attached office of MoHFW led by Director General of Health
Services
• Provides technical advice on medical and public health
matters
• Coordinates with State/UT Directorates via Regional Offices
• Oversees subordinate offices and major central government
hospitals
• Hosts national regulators and knowledge bodies such as
CDSCO, CBHI, and National Medical Library
7. Central Council of Health and
Family Welfare
• Apex advisory body constituted under Article 263
• Facilitates Centre–State coordination on health policy
• Chaired by Union Health Minister; State Health Ministers are
members
• Considers and recommends broad lines of policy on health
and family welfare
8. Other Key Central Agencies
• National Health Authority
implements PM-JAY
• Department of Health
Research and ICMR lead
biomedical research
• NCDC for disease surveillance
and outbreak response
• NHSRC provides technical
support to NHM
• CGHS serves central
government employees
• AIIMS and other central
institutes provide tertiary care
and training
• CDSCO regulates drugs,
medical devices, and clinical
trials
9. Organizational Chart Central Level
MoHFW
Department of Health & Family
Welfare
Department of Health Research
Directorate General of Health Services National Health Authority (PM-JAY)
Central Council of Health &
Family Welfare (Advisory)
CDSCO CBHI National Medical Library
10. State Level State Health
Administration
• Political leadership by State Health Minister
• Administrative leadership by Principal/Additional Chief
Secretary Health
• Directorates include Health Services and Medical Education
• NHM Mission Directorate and State Health Society implement
programs
• Support institutions include SIHFW and SHSRC
11. State Level National Health Mission
Structure
• State Health Mission chaired by Chief Minister provides
overall guidance
• State Health Society carries out functions under the Mission
• State Programme Management Unit supports planning,
finance, and M&E
• Technical support from SHSRC; training via SIHFW
12. Organizational Chart State Level
State Health Mission (Chaired by Chief
Minister)
State Minister of Health
Principal/Additional Chief Secretary
Health
Directorate of Health Services
Directorate of Medical
Education
NHM Mission Directora
Health Societ
SIHFW SHSRC
13. District Level Administration
• District Health Society coordinates all health and family
welfare programmes
• Co-chaired by District Collector; Mission Director is Chief
Medical Officer
• Rural: Zila Parishad leadership is integrated per State design;
Urban: City Health Mission with Mayor
• CMO/Civil Surgeon heads district health administration and
hospital services
14. District to Village Service Delivery
• Community Health Centre for 80,000–1,20,000 population
• Primary Health Centre for 20,000–30,000 population
• Health and Wellness Centre–Sub Centre for 3,000–5,000
(rural) and 15,000–20,000 (urban)
• Sub-District and District Hospitals provide secondary care
• Referral linkages and population norms guided by IPHS 2022
15. Organizational Chart District to
Village
District Health Society
District Collector / Magistrate (Co-
Chair)
Chief Medical Officer / Civil Surgeon
(Mission Director)
Rural Wing Urban Wing
Zila Parishad / Block
Panchayat / Gram Panchayat
CHC / Block PHC PHC / UPHC
HWC-Sub Centre / UHWC
16. Administrative Units and Local
Governments
• State divisions and sub-
divisions (revenue divisions)
vary by state
• Tehsil/Taluk/Mandal as sub-
district revenue units
• Blocks for rural development
and Panchayati Raj
administration
• Villages and Gram Panchayats
as the basic rural tier
• Urban Local Bodies include
Municipal Corporations,
Municipalities, and Town
Panchayats
• ULB health functions cover
public health, sanitation and
primary care units
• City Health Society/City Health
Mission operate under NHM
• Census terms distinguish
statutory towns and census
towns
17. Panchayats and Municipalities in
Health
• Panchayats empowered by
Eleventh Schedule e.g., health
and sanitation, family welfare
• Gram Panchayat and Village
Health, Sanitation and
Nutrition Committee support
community action
• Zila Parishad’s role in District
Health Mission varies by state
• Municipalities empowered by
Twelfth Schedule e.g., public
health and sanitation, water
supply
• Urban Primary Health Centres
and City Health/Urban Health
Societies
• Coordination with Health
Department for disease
control and sanitation
18. Quick Revision for Examinations
• Central: MoHFW has two Departments; DGHS is attached;
CCHFW is advisory
• State: Minister and Principal Secretary lead; DHS, DME, and
NHM State Health Society implement
• District: District Health Society; CMO heads health services;
rural and urban tracks
• Facility pyramid and IPHS 2022 norms for population coverage
• 73rd and 74th Amendments define local self-government
roles
19. Sample Exam Questions
• Draw and label the organizational chart of the health system
at the central level
• Explain the composition and functions of the State Health
Society under NHM
• Write short notes on the Central Council of Health and Family
Welfare
• Describe the district health administration and the role of the
District Health Society
• Write the population norms under IPHS 2022 for HWC-SHC,
PHC, and CHC
20. References and Source Pointers
• MoHFW: About the Ministry; Departments and attached offices (DGHS, NHA).
• DGHS: About DGHS and subordinate offices (CBHI, NML, central hospitals).
• NHM: Institutional Mechanism; Composition of SHM/SHS and DHM/DHS; NHM Portal.
• IPHS 2022: Vol II (CHC), Vol III (PHC/UPHC), Vol IV (HWC-SHC/UHWC).
• Ayushman Bharat HWCs: Operational Guidelines and MoHFW brochures.
• Constitution of India: Seventh Schedule (State and Concurrent Lists).
• Eleventh Schedule (Panchayats) and Twelfth Schedule (Municipalities), official portals.
• Census of India: Concepts and definitions of towns, statutory towns and villages.
Editor's Notes
#2:Keep linking facts to Article 246 and the Seventh Schedule lists (State and Concurrent), and to the 73rd/74th & 74th Constitutional Amendments.
#3:Quote precise entries when answering theory questions. Mention Article 243 (Panchayats) and Article 243W (Municipalities).
#4:Give examples from your state when teaching to increase recall.
#5:Mention that DHR anchors ICMR; DGHS is the attached technical office; NHA implements PM-JAY.
#6:Add examples: Safdarjung Hospital, RML Hospital, and JIPMER are under central government; cite as needed.
#7:Useful for exam: year of first meeting (1988) can be asked in some universities.
#8:Keep the focus on how these bodies connect to service delivery and regulation.
#9:Show CCHFW as advisory; DGHS and NHA as attached/implementing offices.
#10:Use your state’s exact designations (e.g., DHS/DMER) when teaching.
#11:District and City Health Societies function under the State Health Society.
#12:Adapt titles as per state usage (e.g., Health & Family Welfare).
#13:Cite your State’s DHS composition and roles. Many universities ask who chairs DHS.
#14:Remember CHC: 4 PHCs; PHC: ~6 Sub-Centres as a thumb rule (state-specific).
#15:Show parallel rural and urban implementation lines under the District Health Society.
#16:Explain differences between revenue (tehsil) and development (block) units.
#17:Give local examples: ward-level health workers, sanitation drives, and outreach.
#19:Encourage students to practise drawing the three organograms in 3–5 minutes each.
